Temporal and regional variations in use, equity and quality of antenatal care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys

Miguel Pugliese-Garcia, Emma Radovich, Nevine Hassanein, Oona M R Campbell, Karima Khalil, Lenka Benova, Miguel Pugliese-Garcia, Emma Radovich, Nevine Hassanein, Oona M R Campbell, Karima Khalil, Lenka Benova

Abstract

Background: Egypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991-2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health.

Methods: We used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014.

Results: During the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1-7.9) in 1991-1995 to 9.7 (95%CI 9.6-9.9) in 2010-2014. In 2010-2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001).

Conclusions: Egypt's improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.

Keywords: Antenatal care; Demographic and Health survey; Egypt; Equity; care quality; effective coverage; health-seeking; maternal health.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of facility-based ANC users by sector of provision and survey period
Fig. 2
Fig. 2
Distribution of visits reported by users of facility-based ANC, by survey
Fig. 3
Fig. 3
Percentage of facility-based ANC users by sector of provision and survey period in each region
Fig. 4
Fig. 4
Distribution of the number of antenatal care visits among women in need of ANC, by wealth quintile in the period 2010–2014
Fig. 5
Fig. 5
Percentage of women using ANC with one to three, four to seven, and eight or more ANC visits, by region and sector of provision in the 2010 and 2014
Fig. 6
Fig. 6
Percentage of women using public and private ANC that received each of the seven components care studied, stratified by wealth in the period 2010–2014
Fig. 7
Fig. 7
Percentage of women using public and private ANC that received each of the seven components care studied, stratified by region in the period 2010–2014

References

    1. Campbell Oona MR, Graham Wendy J. Strategies for reducing maternal mortality: getting on with what works. The Lancet. 2006;368(9543):1284–1299. doi: 10.1016/S0140-6736(06)69381-1.
    1. Carroli Guillermo, Villar José, Piaggio Gilda, Khan-Neelofur Dina, Gülmezoglu Metin, Mugford Miranda, Lumbiganon Pisake, Farnot Ubaldo, Bersgjø Per. WHO systematic review of randomised controlled trials of routine antenatal care. The Lancet. 2001;357(9268):1565–1570. doi: 10.1016/S0140-6736(00)04723-1.
    1. Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol [Internet]. 2001 Jan [cited 2018 Aug 26];15 Suppl 1:1–42. Available from: .
    1. Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet (London, England) [Internet]. 2001 May 19 [cited 2018 Aug 26];357(9268):1551–64. Available from: .
    1. McClure E.M., Goldenberg R.L., Bann C.M. Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. International Journal of Gynecology & Obstetrics. 2007;96(2):139–146. doi: 10.1016/j.ijgo.2006.10.010.
    1. World Health Organization (WHO). Standards for maternal and neonatal care [Internet]. 2007 [cited 2018 Aug 26]. Available from: .
    1. Kuhnt Jana, Vollmer Sebastian. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122. doi: 10.1136/bmjopen-2017-017122.
    1. Abou-Zahr I, Lidia C, Wardlaw Tessa M. Antenatal Care in Developing Countries Promises, achievements and missed opportunities. 2003 [cited 2018 Aug 26];1–36. Available from: .
    1. World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. WHO Press; 2016 [cited 2017 Dec 4]. Available from: .
    1. Hodgins S, D’Agostino A. The quality-coverage gap in antenatal care: toward better measurement of effective coverage. Glob Heal Sci Pract. 2014;2(2):173–181. doi: 10.9745/GHSP-D-13-00176.
    1. Ng Marie, Fullman Nancy, Dieleman Joseph L., Flaxman Abraham D., Murray Christopher J. L., Lim Stephen S. Effective Coverage: A Metric for Monitoring Universal Health Coverage. PLoS Medicine. 2014;11(9):e1001730. doi: 10.1371/journal.pmed.1001730.
    1. Benova Lenka, Tunçalp Özge, Moran Allisyn C, Campbell Oona Maeve Renee. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Global Health. 2018;3(2):e000779. doi: 10.1136/bmjgh-2018-000779.
    1. Arsenault Catherine, Jordan Keely, Lee Dennis, Dinsa Girmaye, Manzi Fatuma, Marchant Tanya, Kruk Margaret E. Equity in antenatal care quality: an analysis of 91 national household surveys. The Lancet Global Health. 2018;6(11):e1186–e1195. doi: 10.1016/S2214-109X(18)30389-9.
    1. Campbell O, Gipson R, Issa AH, Matta N, Deeb B El, Mohandes A El, et al. National maternal mortality ratio in Egypt halved between 1992–93 and 2000. Bull World Health Organ [Internet]. 2005 [cited 2017 15];83(6). Available from:
    1. World Health Organization, UNICEF, UNFPA, World Bank Group, United Nations. Trends in Maternal Mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA: World Bank Group and the United Nations Population Division; 2015.
    1. Kassebaum NJ, Barber RM, Bhutta ZA, Dandona L, Gething PW, Hay SI, et al. Global, regional, and national levels of maternal mortality, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study 2015 [Internet]. Vol. 388, The Lancet. 2016 [cited 2018 Aug 26]. Available from: .
    1. Gipson Reginald, Mohandes Ayman El, Campbell Oona, Issa Adel Hakim, Matta Nahed, Mansour Esmat. The Trend of Maternal Mortality in Egypt from 1992?2000: An Emphasis on Regional Differences. Maternal and Child Health Journal. 2005;9(1):71–82. doi: 10.1007/s10995-005-3348-1.
    1. Ministry of Health and Population of Egypt, El-Zanaty and Associates, ICF International. Egypt Demographic and Health Survey 2014 [Internet]. 2015 [cited 2018 Dec 3]. Available from:
    1. Boerma Ties, Ronsmans Carine, Melesse Dessalegn Y, Barros Aluisio J D, Barros Fernando C, Juan Liang, Moller Ann-Beth, Say Lale, Hosseinpoor Ahmad Reza, Yi Mu, de Lyra Rabello Neto Dácio, Temmerman Marleen. Global epidemiology of use of and disparities in caesarean sections. The Lancet. 2018;392(10155):1341–1348. doi: 10.1016/S0140-6736(18)31928-7.
    1. Boerma JT, Bryce J, Kinfu Y, Axelson H, Victora CG, Bernstein S, et al. Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet [Internet]. 2008 12 [cited 2018 Dec 3];371(9620):1259–67. Available from: .
    1. Powell-Jackson Timothy, Macleod David, Benova Lenka, Lynch Caroline, Campbell Oona M. R. The role of the private sector in the provision of antenatal care: a study of Demographic and Health Surveys from 46 low- and middle-income countries. Tropical Medicine & International Health. 2014;20(2):230–239. doi: 10.1111/tmi.12414.
    1. Al Rifai RH. Trend of caesarean deliveries in Egypt and its associated factors: Evidence from national surveys, 2005-2014. BMC Pregnancy Childbirth [Internet]. 2017 [cited 2018 Sep 3];17(1):417. Available from: .
    1. Filmer D, Pritchett LH. Estimating Wealth Effects without Expenditure Data-or Tears: An Application to Educational Enrollments in States of India. Demography [Internet]. 2001 Feb [cited 2018 Sep 3];38(1):115. Available from:
    1. Rutstein SO, Johnson K. The DHS Wealth Index. DHS Comp Reports No 6. 2004;6:1–71.
    1. Benova L, Campbell OM, Ploubidis GB. A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt. BMC Health Serv Res [Internet]. 2015;15(1):1. Available from: 10.1186/s12913-014-0652-8.
    1. Country Cooperation Strategy for WHO and Egypt. 2010 [cited 2017 Dec 15]; Available from: .
    1. Benova L, Campbell OM, Sholkamy H, Ploubidis GB. Socio-economic factors associated with maternal health-seeking behaviours among women from poor households in rural Egypt. Int J Equity Health [Internet]. 2014;13(1):111. Available from: 10.1186/s12939-014-0111-5
    1. Gadallah M, Zaki B, Rady M, Anwer W, Sallam I. Patient satisfaction with primary health care services in two districts in lower and upper Egypt. EMHJ - East Mediterr Heal J [Internet] 2003;9(3):422–430.
    1. World Bank. Management and service quality in primary health care facilities in the Alexandria and Menoufia governorates [Internet]. 2010 [cited 2017 Dec 8]. Available from:
    1. Zaky HHM, Khattab HAS, Ma NN. Experiences of women using reproductive health services in Egypt: One health system in two governorates. Qual Prim Care [Internet]. 2010 [cited 2017 Mar 20];18(5):345–52. Available from: .
    1. World Bank. A Roadmap to Achieve Social Justice in Health Care in Egypt [Internet]. 2015 [cited 2017 Dec 8]. Available from: .
    1. UNFPA. Population Situation Analysis of Egypt [Internet]. 2016 [cited 2018 Sep 3]. Available from: .
    1. World Bank Group. World Development Indicators | DataBank [Internet]. 2018 [cited 2018 Dec 21]. Available from: .
    1. Ghanem H. Improving regional and rural development for inclusive growth in Egypt [Internet]. Vol. 67, Global Economy and Development at Brookings. 2015. Available from: .
    1. Chiang C, Labeeb SA, Higuchi M, Mohamed AG, Aoyama A. Barriers to the use of basic health services among women in rural southern Egypt (Upper Egypt). Nagoya J Med Sci [Internet]. 2013 [cited 2017 Dec 8];75(3–4):225–31. Available from: .
    1. Rashad A, Sharaf M. Who benefits from public healthcare subsidies in Egypt? Soc Sci [Internet] 2015;4(4):1162–1176. doi: 10.3390/socsci4041162.
    1. Brasington Angela, Abdelmegeid Ali, Dwivedi Vikas, Kols Adrienne, Kim Young-Mi, Khadka Neena, Rawlins Barbara, Gibson Anita. Promoting Healthy Behaviors among Egyptian Mothers: A Quasi-Experimental Study of a Health Communication Package Delivered by Community Organizations. PLOS ONE. 2016;11(3):e0151783. doi: 10.1371/journal.pone.0151783.
    1. Khadr Z. Monitoring socioeconomic inequity in maternal health indicators in Egypt: 1995-2005. Int J Equity Health [Internet]. 2009 Nov 8 [cited 2017 Dec 15];8:38. Available from: .
    1. Egyptian guidelines.
    1. Huntington D, Zaky HHM, Shawky S, Fattah FA, El-Hadary E. Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt. J Health Popul Nutr [Internet]. 2010 [cited 2017 Dec 4];28(3):273–80. Available from: .
    1. Zaky HHM, Armanious DM, Hussein MA. Testing for the endogenous nature between women’s empowerment and antenatal health care utilization: evidence from a cross-sectional study in Egypt. Biomed Res Int [Internet]. 2014 [cited 2017 Dec 4];2014:403402. Available from: .
    1. UNICEF. Reaching Universal Health Coverage through District Health System Strengthening: Using a modified Tanahashi model sub-nationally to attain equitable and effective coverage [Internet]. Maternal, Newborn and Child Health Working Paper, UNICEF Health Section. 2013 [cited 2017 Dec 8]. Available from: .
    1. Liu Li, Li Mengying, Yang Li, Ju Lirong, Tan Biqin, Walker Neff, Bryce Jennifer, Campbell Harry, Black Robert E., Guo Yan. Measuring Coverage in MNCH: A Validation Study Linking Population Survey Derived Coverage to Maternal, Newborn, and Child Health Care Records in Rural China. PLoS ONE. 2013;8(5):e60762. doi: 10.1371/journal.pone.0060762.
    1. Tomeo Catherine A., Rich-Edwards Janet W., Michels Karin B., Berkey Catherine S., Hunter David J., Frazier A. Lindsay, Willett Walter C., Buka Stephen L. Reproducibility and Validity of Maternal Recall of Pregnancy-Related Events. Epidemiology. 1999;10(6):774–776. doi: 10.1097/00001648-199911000-00022.
    1. McCarthy KJ, Blanc AK, Warren CE, Kimani J, Mdawida B, Ndwidga C. Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya. J Glob Health [Internet]. 2016 [cited 2017 Dec 15];6(2):020502. Available from: .

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner